Thanks, Mary-Kate. Hello, everyone. I'd like to welcome you today, and thank you, our guests, for being here. Today, you are here for Working with Children and Youth with Problematic Sexual Behavior. This webinar is being brought to you through IAFN's Technical Assistance Project. We're grateful to be able to host Jeff Sedoli for today's webinar. Before we get started, I want to just introduce myself. I'm Angelita Oluwu. I am Forensic Nursing Director with IAFN. And a little bit of disclosure and housekeeping information. So this presentation is funded through Office on Violence Against Women grant. The U.S. Department of Justice has no—oops, sorry. The opinion, science, conclusions, and recommendations expressed in this presentation are those of the authors and do not necessarily reflect the views of the U.S. Department of Justice. We are recording today's webinar. Once this webinar has been archived to our SAFE-TA.org website, you will receive an email from IAFN to update you that it is available for view. If you have multiple people viewing with you today, please send a list of attendees that have not formally registered for the webinar to SAFE-TA at forensicnurses.org. So S-A-F-E-T-A at forensicnurses.org. And we'll be able to share the evaluation link with them at that time. I'd also like to mention that as a benefit of membership, IAFN members are eligible to receive 1.5 contact hours for continuing education activity. The IAFN is an approved provider of continuing nursing education by the American Nurses Conditioning Center's Commission on Accreditation. For IAFN members to obtain CE for this activity, they will need to attend the webinar in full and complete the post-activity webinar evaluation that will be dropped in the chat. Once this presentation is over, it will also pop up at the end. But with that being said, I do want to just take note that IAFN is currently in the process of changing the vendor that we are, that we have our online learning management system through. So all evaluations for CE certificates will come to all attendees via email after January 2nd. So you will get a link today, and then it'll note that you'll have two questions on there that ask you if you're a nurse and if you're trying to get CEs. And then that information will allow us to prompt an email to you after January 2nd. If you're not attending, if you're not attending with the purposes of getting CEs, you will have the opportunity to continue through the evaluation at the end of the webinar to get your certificate of attendance at the end. In addition to that, I would like to just take a few more minutes and really thank Jeff for being willing to be here today and being willing to close out 2024 with us here at IAFN for our last webinar of the year. Jeff, I'm going to turn it over to you for you to introduce yourself. Thank you. Great. Thanks, Angela. I appreciate it. So welcome, everybody. Thank you for being here. I know this is like, what, five days before Christmas, and so I appreciate you being here because this is a crazy time of year, right? We don't get anything done. We're running around with our hair on fire. So thank you for all being here. Real quick, yeah, my name is Jeff Stodoli. I'm the National Coordinator for Mental Health Programs with the National Children's Alliance, which is a big, long title, which means I do a lot of mental health work. My background is I'm a licensed clinical social worker. Prior to coming to NCA, which was just seven months ago, I was an executive director at a CAC in Asheville, North Carolina. Prior to that, for about 25 years, I evaluated and treated those who caused sexual harm, adults, adolescents, and young children. And that's all I did for about 25 years. So that's really the depth of my experience going back to the 80s. So with all that said, I have a good amount of slides today, but here's the thing. I'm going to cover most of the content here, but I really want this to be a good experience for you guys. And I know we're in webinar mode, which means I can't see you, which I hate, and I can't hear you because you're getting off mute, but please use the chat feature if you have questions, if there is something I am talking about and you want me to go into more depth about. It's really good. I mean, it's early afternoon here in North Carolina. I know it's morning on the West Coast, but it's well past my coffee. And at this point, my Adderall has worn off and I'm easily distractible. So you can get me talking on a lot of different topics. So if I hit something and you would like, hey, Jeff, can you talk a little bit more about that or ask a question or have a case situation, please just stop me because I'd really much rather talk to you about what's important to you rather than cover all the content that I have, because I think it'll be interesting, but I really want to make sure I pay attention to what's going on with you and what you want to hear. So here's what I'm going to try to cover today. And so really, what is PSB, problematic sexual behavior? I'll call it PSB. What does that look like in kids and youth? What are some of the best practices? What do we know to work with kids and things that don't work too? And I'll talk a lot about how we take individual strategies with them and what that means. And really that this is a heterogeneous group, which is a big word for saying is they're all different. What I always say is if you've worked with one kid with PSB, you have worked with one kid with PSB. They're all very different. There's not a really typology to some extent. So, and I do a lot of training on interviewing, and I know that's what a lot of you guys do. So I threw a little bit of that into there as well. But again, please let me know if there's more specific things you want me to go into. So starting off with, here's probably where I always start with is what to remember is what to call them and again, what not to call them. We have plenty of research on labeling theory that tells us when we use bad names on people, they tend to do more bad things. So calling them predators, pedophile, even most of this stuff, I'm not even sure what it is, to be honest with you. When we talk about predators, we use that term all the time. Most states don't have a predator designation on their registry or something, but the protocols are pretty iffy about having to know what that means and what they look like because they vary great across the board. So in the basic premise is don't use, don't call people bad names. Remember what they told you in like kindergarten? And a lot of that applies now. So talk about like person first language, what they did. So again, I talk about kids with problematic sexual behavior, kids with sexually problematic behavior or abuse reactive behavior, where something bad's happened to them and then they've done something bad. So again, using, so I will use the term initiator today, talking about the kid who initiates it and I want to talk about the impacted child as the one that was harmed or potentially harmed. So again, not using terms like offender and perpetrator with these kids, they really just tend to do bad things. So what is problematic? Because it's in the eye of the beholder lots of times. And lots of times it's based upon adult norms, adult beliefs, adult experiences, adult perspectives on values, religious beliefs, moral beliefs, family beliefs. So lots of times it's very personal about what it's called. So I use this kind of little spectrum to talk about anything from normative and even normative is still up for grabs today because if you haven't heard of this thing called the internet, it's out there and it's exposing kids to a lot of sexual content. So normative has even adjusted to some extent. And then moving into what we call concerning, again, these are behaviors that are causing stress or anxiety, either on the initiating child or on the impacted child or things like we try to intervene, but it necessarily hasn't worked or they need intervention to stop the behavior. It's developmentally incongruent. I always say it's four and five-year-olds play doctor, but they shouldn't be playing OBGYN. And that's very different. So again, developmentally congruent, what's going on with them. And then harmful gets a little bit easier to determine because we're talking about, again, obviously physical harm is easier to identify, which we don't usually get, but the emotional, psychological, and is the behavior being facilitated through exploitive manners are the child fixated on it, even when you intervene and stop it, keep coming back to it. And then there's an extended adverse response. Like after the, you can see that the child is getting like changing dramatically and emotional or cognitive or behavioral states because of the sexualized behavior and the interventions of the sexualized behavior. So really kind of pay attention to all that. So again, I say evaluate each case on a case-by-case basis. And I talk about a developmental contextual pathway. That means is what were the, what were the cards they were developed dealt developmentally? So what was their nature? What were they born with? And then there's the nurture part. What was their life experiences? So I often will, people will tell me like, I've got this kid. He has no empathy. He doesn't care about anybody. And then I'll meet his family and I'll be like, oh, now I know why this kid has no empathy. He's never experienced empathy. So if you haven't experienced it, how can you necessarily then be held for blame for not having that empathy? Right? So if you haven't experienced accountability, how do you expect them to demonstrate accountability? So again, the developmental pathway through the context of their life experiences. And again, we, one of the things is we haven't had a real good national study on what normative sexual behavior in at least adolescents. But I think kids in general, in a long time, we've had studies on like impact of pornography, sexting, different types of specific things that kids are doing, but not like an overall, like how many kids are engaging in oral sex? How many kids are engaging in vaginal sex? How many kids are, you know, engaging in different types of, again, what's normative and not normative. We kind of have a bit of a normative, like on pornography use, but not overall sexual behaviors, so to speak. And again, I always, it's kind of a joke, but it's not a joke that problems are mostly defined by adult culture, right? It makes some adult uncomfortable. They don't like what the kid's doing. And they're like, that kid has a problematic sexual behavior. I can give you an example. One time I had a therapist call me up one time and said, I have a child and he's excessively masturbating. So I said, okay, so tell me about the, what's going on. And she said, he's masturbating one time a month. And I went, okay, one time a month, this is a 14 year old. And I said, so I went through my list of questions. Is he doing it where it causes physical harm or he needs medical attention? Is he doing it in public where people can see it? Does he do it on purpose so people can, and no, no, no, no. This kid was in the bathroom and one day his mom walked in on him and caught him. And when they asked him how often he was doing that, he said one time a month, and the therapist said, that's problematic. So at that point, I knew more about the therapist's sexual interests and beliefs than I did about the kids. So again, we tend to project our own values onto that. And we all have opinions and perspectives on sex and sexuality, folks. That's just the kind of way it is. So what a problem is again, lots of time it's in the eye of the beholder. So it shouldn't be problematic for us. It's got to be problematic for the child or the children involved. So we need to be paying attention to that. So this is where people will say, how do you know if it's problematic? This is what it comes down to. And usually when I'm in a larger audience, I ask, which is like your SAT questions. Those of you who remember that, which one of these words is different than the other three words. If you want to put it in the chat, you can, but one of these words is very different than the other three. There's three that kind of go together. And so I always ask about this, what people think. And so I'm trying to check my chat. Compliance, coercion, cooperation. Good, good, good. Thank you. I appreciate your participation. So what it comes down to is it's consent. Consent is different than compliance, cooperation, or coercion. Because think about compliance. If you get pulled over by a police officer for speeding, you comply. You'd rather not get a ticket or not have to talk to the police officer to do it. If your boss tells you to get something done by Friday and you just don't have time, but you'll do it because you will cooperate. So this is where most of the problematic sexual behavior that I work with or have worked with over the years, this is where it happens, is in that compliance and cooperation. Coercion is usually pretty clear. There's threats. There may even be violence. There might even be weapons involved. That's clearly some kids trying to influence another. But compliance and cooperation is that gray area. That's where I have worked 90% of my career is in those two areas. Consent is very clear. There should be nothing influencing consent. They shouldn't be worried about consequences. They shouldn't be worried about whether this would be good or bad for them to do it. But with compliance and cooperation, it gets really muddy and really gray pretty quick. So when we think about how much of an issue this is, so if you look at percentages, so this is both violent and people committed violent offenses and sexual offenses. Again, I don't like to use offenders. And if you can look at the age range, all the way to the left there, age 14, so 14-year-olds in this country initiate most of the sexual, not most, but that's the most common age that perpetrates or causes the most sexual harm. So when you look at it, it starts to gradually go down, a little bit of a peak back in the 30s, and then it drops off steadily. Well, you're kind of see down to like around 70-ish because that's when grandpa retires and he has more time to hang out with the kids. But so when we ask about why is this an issue for kids? Because 14-year-olds, that age group is actually initiating most of the sexual, that age is the age that initiates most of the sexual, if you compare it to every other age range as they go down, you can see it steadily kind of drops off really specifically after around 35. So that tells us a lot of different things. One, we need to be paying attention to these kids because if it's happening that early, we really should be intervening and doing something about it. Because we talk about numbers across the board, thankfully, but between 14 and 17, that's not the majority of the population. But if you look at who's, again, initiating that, it's an issue we need to pay attention to. So Michael Caldwell, who's kind of the king of research around recidivism with juveniles, and this is all kids who've been in the juvenile system. So I say recidivism, it's kids. So his studies, basically, if you look at that middle box, that bottom number, his studies show, and in fact, it's decreased even in the past, since between 2000 and 2015. So recidivism was around 2.75%. That's really low. And by CDC standards, that's a cure rate. If you can get below, I think, 8% or 5%. So 2.75% is really, really pretty low, comparable. And in fact, so these are kids who got caught and got treated. And then subsequently, then we caught them again the second time. So given that, I actually have a poll question I would like to ask you guys. So I'm going to launch it, if you wouldn't mind. So this is a question asking the likelihood of continued PSP. This means any type of sexual, whether they were caught or not, whether they got treatment or not, just across the board, every kid, what is the likelihood of continued recidivism or continued problematic sexual behavior? So I'm just going to give this a minute. There's about 30 of you. I definitely would want to hear from all of you if I can, because I really would like your perspective on that. So we're about halfway there. Looks like we got a decent mix. I'm going to wait because I'd love to get more of you get some input. Just takes a second to click on it. And I'm one of those therapists, I can sit in silence. I'm always good at it as a therapist. Or I like to think I'm still a therapist. Okay, I'll stop it there. I know we were time-wise. So things you can see about most people fell upon the 18% and the 33. So the correct answer, the two of you that picked 8%, you are correct. Patrick Lussier just did a study that came out this year. And in that study, he looked at recidivism rates in adolescents going back to the 30s, 1930s. I didn't even realize we had studies going back to the 1930s. But what he showed is kids across the board, whether they had treatment, whether they didn't have treatment, all of them together, when he bulked every single kid together, he could find in, I think it was like 155,000 different individual youth. He found that 8% of them recidivated. That's still really low, right? So, and when you look at kids who don't get treatment, I think their recidivism rate is somewhere in the 18% range, 15 to 18%. So still not high. I like it to be zero, but still not what I would consider high. So again, when we're looking at treating these kids and working with these kids, my point of all this, and lots of times when I talk to DAs about this or district attorneys is that treatment works. You should be working with these kids and not just not trying to punish them or punish this out of them. So I'm going to break this up into age ranges here. So we talk about kids 12 and younger, because definitely there's differences between young kids and adolescent kids. When we look at these younger kids, we can see that this was a study done back in 2006. It was a ATSA task force. Those of you know, ATSA, which is the Association for Treatment and Prevention of Sexual Abusers. Again, what they are finding is that, look, when we talk about problematic sexual behavior, younger kids initiate behaviors involving sexual body parts. This is what it looks like. They define it as genitals, anus, buttocks, breasts, and that it's inappropriate, potentially harmful to themselves or to others. Because sometimes the problematic sexual behavior doesn't involve another kid. It's what they're doing to themselves that may be problematic, that they're harming themselves. So when we look at the prevalence with young children, and sorry, I don't know what the one is. I think that's 12 and under, it's supposed to say. The reports look like when coming in to, what we're looking at is occurring about 42 to 73% of the children at the time, they reached 13 years of age, that it's not uncommon for sexual behaviors in children. Again, that's not harmful, but that's sexual behaviors. And again, a Russell study in 2014, roughly about the same 40 to 85% of children will engage in some type of sexual behaviors. So we know kids are sexual beings. We don't expect them not to do any type of sexual behavior. But when we look at problematic, Friedrich, who's again, a great researcher said about, looked around about 6% of children presenting for mental health treatment. Again, the caveat is they were presenting for mental health treatment. So there are probably other things going on with them, but about 6% of those kids had some type of sexual behavior problem, serious enough that they were considered needing an intervention. Again, a few more studies, NCA, National Children's Alliance. The CACs recently looked at this in the past couple of years and basically it varies a little bit by region and CAC, obviously, but reports vary between about 25 and 40% of all sexual abuse cases coming in involved two children or child on child. And interestingly enough, I guess before with younger kids, we tend to see that girls are causing or initiating about as much of the sexual behavior problems as boys that dramatically changes when they become adolescents. But when they're in that 12 and under, it's just as likely to see a female as a male initiating those behavior problems. So again, not much difference there when we look at it. When we start looking at adolescents again, again, we know those 14 year olds are the ones initiating a lot. But so when you look at this youth again, this is 13 to 17 and engage in sexually abusive behavior or maybe at risk engaged in sexual behaviors includes adolescents. This is kind of how I define it, includes adolescents involved in the child welfare and juvenile justice system, because they tend to either go into the juvenile justice system or they stay in the child welfare system as we're defining them. But when we look at numbers again, on the Federal Bureau of Justice Statistics, we'll say about 20 to 30% of all rapes in this country are initiated by juveniles. And that again, about 30 to 40% of all sexual abuse. So a fair amount, right? A third at least, or maybe even a little bit more. And even Ybarra's study in 2018, he found that about roughly a little less than 10% of kids when he talked to kids 14 to 20, and again, 18, 19, 20 is out of that kind of adolescent, well, 20 is, he found about, they report about 10% of them report that they initiated some type of unwanted sexual touch, whether it's kissing all the way through extreme. So it's there, it's an issue and we really should be paying attention to it. The thing about adolescents, and you guys may know this, adolescents is a tricky age, right? They do a lot of change developmentally, biologically, neurologically. One of the things we know, we know kids go through this puberty change when they're adolescents. But the other thing we know that dopamine peaks around right before puberty, basically, depending. And then once puberty initiates, we see drops in dopamine levels begin to occur throughout your adult life. As you get to, those of us in our 40s and 50s know, it really starts bottoming out. But you also see increased levels of testosterone in adolescents. So what, and I know I'm talking a bunch of nurses, so I know you guys know what dopamine does. I know how it impacts pain reduction. It creates a pleasure for certain, when you eat chocolate, dopamine is released. When you have sex or an orgasm, dopamine is released. So ways of replacing dopamine when it drops off for adolescents, what can they do? Well, they can experiment with drugs and alcohol. They can take risks. They can experiment sexually. All that stuff generates dopamine. So as their levels are dropping, we're seeing kids trying to replace those drops through these kind of delinquent behaviors that create, or the oppositional, maybe not delinquents too much, but sometimes delinquent behaviors. So we've got this increase in testosterone, decrease in dopamine. I don't have to talk to you guys about brain development. They're still working on more gut instinctual. So a lot of their behaviors look really problematic, right? There's a reason why adolescents, I've raised two of them, are really difficult. It's kind of like this cruel trick that adolescents go through it. We know why that biologically they're wired to drive us nuts and be a pain in the butt. So when it comes to sexualized behaviors, yeah, we understand why some kids are initiating risky or even dangerous sexual behaviors. So a little bit more neuroscience. Again, when we're talking to kids, and I know I have a lot of interviewers here, so I apologize if this is redundant for some of you, but I know some of you may not. I definitely want to talk about what the neuroscience is. So when we're asking kids about like what's good and what's bad, research has shown that they don't always be able to distinguish those equally. And again, while the correct responses for both adults and adolescents are similar, adolescents took significantly more time to figure out if this was bad thing or not. So their determination, whether it's good or bad, and again, think about it. Adolescents don't have that many life experiences. So when they're taking an experience and they're looking back in their memory bank and trying to compare it, whether this is good or bad, they don't have nearly the context, again, context and development that adults do. So often they're not great at initiating or understanding, this may not be the best idea, but I'll go ahead and do it anyways, because it's not unusual for them to do that. So again, a little bit more about questioning. So four points to remember about questioning. Again, the first requirement is that they understand the question from beginning to end. And a couple of things play into this. One is lots of kids, about a third of kids have an, actually a third of all human beings, I shouldn't say kids, adults have this too, they have auditory processing issues. So the type of language you use matters. And if it's an accent or depending on there's background noise or two people talking at the same time, auditory processing disorders. I used to run residential units and they complained and said, that's just crap, they're just lying and it has nothing to do with that. And so I did an auditory processing screen on all the staff and about a third of my staff had auditory processing issues. And I'll give you an example. I had a kid years ago who at the residential, he was screaming and cussing out. He's like, I'm not an appliance. I'm not a GD appliance, you effing this. I'm not an, I pull him to the side. I'm like, what's going on? I calmed him down and talked to him. He's like, they keep telling me that I'm out of an appliance. And they were telling him he was out of compliance with the rules. And what he heard was, I'm an appliance. So he thinks they're calling them a stove or a refrigerator and they're just saying you're out of compliance. And I did an auditory processing screen on him and he was from up North and I'm down South and the Southern accent, he didn't understand as well. It was one of the ways that he had, his processing was incorrect. So sorry, long answer to that one, but pay attention to them understanding the question and literally understanding the language. And you guys have probably read through all these already, but again, you can't give an accurate answer if you haven't processed it. And response to the question is not necessarily an answer to the question. I always ask follow-up, I use reflection. So if a kid says, well, that was her just asking me to do it and I'm like, so you're feeling like she was the one that initiated it. I wanna be clear, are you saying she initiated it? Cause he may be saying that or not. So I use a lot of reflective responses with kids to try to get them to know that, get clarification. And again, I like to use nouns and verbs. I'm not a big fan of adjectives and adverbs because if I say, if someone says, oh, that's concerning or that's significant, going back to my story about the therapist who said that that kid was his masturbation was excessive. I don't know what's concerning to me may not be concerning to you. So when a kid says to me, well, I'm watching pornography about five hours a day, I'm doing it between midnight and five in the morning and I'm doing it about five days a week. That to me says, okay, you might have a problematic issue with watching pornography rather than just saying he has significant pornography viewing. That doesn't tell me as much. Also, I know when he's doing it, I know what he's doing. I know what he's watching and I don't know how often. So I wanna figure out those. So again, I really encourage the use of nouns and verbs and less with adjectives and adverbs. I joked earlier about having some being okay with silence but really being okay with silence. I'm a therapist and therapists hate silence. They feel like they've got to fill the void. And again, I know I'm talking to a lot of experienced interviewers but paying attention to that on average, it takes kids about 10 seconds to process information. So when I ask a question, just wait back. And the other thing is if the kid answers the question before I even get it out, I'm also kind of like I'll take a second to follow up on that as well. Again, I keep saying this, but beware of auditory processing disorders, ask clarifying questions and reframing. All of you probably know this really well about like when it happened, where it happened. Like when they'll say, oh, that happened, I don't know exactly, sometime last year. And then you do clarifying questions like what was the weather or was it around a holiday? Was it doing things like that? And I always talk about if you're taking notes in your exam, be careful, especially when you're interviewing adolescents about their sexual behavior. If they sit there and say, well, I've been masturbating to pornography lately and you start writing down something, they're gonna be like, oh crap, I shouldn't have said that. And they're gonna be reading you just as much as you're reading them. So be aware of how you take notes or facial expressions are really important, right? So if you go, so tell me again, I don't know if you guys can see me in the camera, but if you go, tell me again about like when you're looking at pornography, my face says there's something really gross and weird about that. And they're gonna read that. And he's gonna answer, I don't look at any pornography or I don't do that behavior at all, whatever. So paying attention because your posture, your facial expressions, all those things we wanna pay really close attention to. I used to, as new therapist, I would, my dare to them was do a whole interview with a kid and don't do this, don't nod your head. Try not nodding your head in an interview ever for the whole interview. My record is about 43 minutes. And I thought I was gonna have a seizure because I was trying to hold my head and I felt like, oh my God, I'm gonna explode. But if you're nodding your head, in a way you're leading the conversation, you're adjusting their responses. What happens if they're telling you something that that's not true and you're going, okay, so you've never even heard of sex. Okay, and I'm going, yes, I'm actually maybe encouraging that type of response. So paying attention to those things. So I am talking a lot, I'm paying attention. I haven't seen anything in the chat. If you guys want to stop, please stop and jump out. Oh, I jumped ahead, sorry. I also talk when I'm interviewing kids. And again, I should have talked about this a little bit earlier, so I apologize. When I'm talking about interviewing kids, I'm talking about a more in a mental health assessment process. Forensic interviews have a specific purpose there that is to capture information, accurate information about what has happened to a child. I am not telling you to do forensic interviews to try to capture what a child has done. That is different. This is more like in a mental health or if you're in a position to interview a kid to try to figure out what the issues are for treatment or such, that's fine, but not in any type of investigative process. So I apologize. I should have said that a little bit earlier. So my fault on that one. So my bad. But what I do talk to kids about early on interviews is I really, like you tell my old staff would tell me, never say to Jeff, hold them accountable because I hate that statement. Holding people accountable, kids, adults, whoever it is, one, it makes me do all the work, and two, it teaches them nothing. My goal is to create accountability within somebody. So as you can see in the slide, I talk about inviting, enticing, and encouraging responsibility. How do you do that? How do you encourage that internal responsibility? Because when I go away, I want that responsibility to come from inside of them, not from me. I don't want them to do it for me or because they're going to get in trouble, or it's coerced, right? They're doing it out of compliance. I don't want them to be compliant. I want them to consent to being responsible. So I talk about identifying the benefits that come with it. What's the payoff? If you're honest, what do you get? Do you get more freedom? Do you get more responsibility? Do you get more trust? So really kind of talking about that with them, and then having them really address their behavior, whether it's sexual or not, but what's problematic and explain to me. So I'll use open-ended questions like, tell me about the things that get you in positions of being in trouble or having consequences. And then again, I'm not going to go through all these, but really taking the approach of how do I create accountability? How do I encourage them to be accountable rather than like you're going to listen and do this again, holding them accountable is making them do something they don't want to do. And if they're initiating problematic sexual behavior, that's the same dynamic I'm trying to overcome, right? I'm trying to get them to figure out, don't try to make people do things they don't want to do. But if I'm trying to do that to them, it seems a little contradictory, right? Yeah. So I struggle with that. And over the years I've had kids say that to me, well, you're just making me do things I don't want to do, kind of what you're doing to me right now. And I'm like, yep, you're right on. I cannot argue with that at all. So I talk about truth and deception because you want to pay attention to this in interviewing, because again, in a forensic interview, I know we handle this differently, but we, in these types of interviews, we also address them not to catch them and go, aha, I caught you, there you are. It's more about like paying attention to things they may not want to talk about or areas where they're concerned about. I want to pay attention to that and make a mental note or an actual note so I can get back to that and do that. But I always, again, given that initial conversation of like, look, obviously we want you to be truth, tell the truth. I don't want you to get in trouble. So often in the forensic interview, we give those examples and you can do the same thing. The little twist here for working with kids like this is I talk about, I never, I want you to be honest, but I never want you to admit to anything you didn't do. I really kind of hammer that home because that's the type of lie I really don't want to have because then you're going to get falsely accused. And I want you to be, again, I want you to be accountable and responsible, but I don't want you to be accountable or responsible for things you didn't do because that's going to burn them and immediately you're going to lose them with that. So, and I also want to give kids out. The worst thing you can do is corner a kid and if they get nervous and jumpy because they know they're lying and they realize I know they're lying, not from anything I did, but it's just so obvious. I will say, okay, and I back off, I back away. I don't push, I pull, right? I always talk about pulling and not pushing. I will say, hey, it's okay. Look, if there's something right now you're not feeling comfortable talking about, that's okay. I don't want you to be in a position where you might have to lie or it gets you uncomfortable. I want you to be able to say that. I don't want to talk about that or I may come back to that later, but that's not something I want to address right now. I want to give them an out. The worst thing you can do is never give them an out. It's like, you know, cornering a caged animal, right? That's the worst time. You always want to give them an out. So again, I don't want them to feel forced into anything. I want them to feel like they've got options. I'm not going to also say, oh, well, we're never going to address that ever again. I will tell them, look, this will probably come back up. Maybe not now, maybe not with me, but maybe with somebody. So I'm giving you the option to do it now, knowing that it may not, it's not necessarily going to go away, but for the moment, if it helps us move forward, I'm okay with that. And again, when I'm talking about accountability, sometimes I'm okay if they're willing to talk about accountability moving forward compared to moving backward, but because obviously I want them to be accountable moving forward. So a couple, when I talk about use of deception, this was from Rudisill, who was a great interviewer for the FBI years ago. And he came up with this, it's a training I do called 17 lies, 17 ways to lie without lying. And Rudisill had this great setup about basically this is a way to be, I always say, not everyone lies, but everybody's deceptive. Even you and I are, right? Like when the policeman pulls you over again and they say, do you know why they pulled you over? Who says, I know officer, I was doing 85. I can't believe you didn't pull me over earlier. We all sit there and go, no officer, I don't know why you pulled me over. So we're all deceptive in some ways. So I don't want to pathologize this at all, but these are common ways that all of us are deceptive, not just people who get into trouble. But when you hear these types of responses, the could, should, would, oughta, or again, I talked about that they're too quick or too long. Again, remember kids need a little bit longer to answer. But if you're saying, were you in the no, and they just say, they blurt out no, right? It's like before you get the question out, obviously they can't answer a question they don't know. You want to pay attention to that. Most common one I probably hear from kids is, I just don't remember, or I don't know. And that's a good way of saying, well, okay, so something might happen, but you just don't remember. And that's okay if you can't remember right now. It kind of is a way to say, look, I doubt there, gives them an out, but you address that it's there. But it's not in a blaming, shaming way, right? And being careful about that. So some of the more interesting ways kids can say is like the denial of presence. I always like, are you asking me that question when you're just the only two people in the room? I'm like, yeah, yeah. So you're wondering if there's anyone else I'm asking that to. And we kind of walk, go through those motions, but, or like incongruent to the question, like you asked them about what happened with them and their sister. And they're like, well, you know, I was at school and this kid at school. And they're like, okay, all of a sudden we jumped from a different place and different people were way. So it's not that I don't let them say it out, but I come back to it. So being, again, being aware of these things, not sitting there going, oh, I caught you. You've been lying to me. I want to make mental notes. So I know that I, or someone else is going to come back to that because that might be an important issue to follow up on in a non-confrontative, non-combatant way. So, of course, when we're talking about deception and lies, most of us, or I train a lot of law enforcement folks and I love law enforcement. They're great. But I think there's a kind of misbelief that we can tell when people are lying and not just in law enforcement, but other disciplines as well. So there was a really good meta-analysis done back in 2017. Here's the simplicity of it, folks. When they looked at it in the general population, can you tell if kids are lying? 54% of the population could tell when a kid was lying. That is about, that's a flip of a coin, right? 50% is, you know, it's just a little bit above. When they took professionals like you and me, we were at 56. So we weren't dramatically better at that. So the only place where accuracy went up is that last bullet, when we are looking at very young children and the least accurate we were is with older children. And that makes sense because as kids get older, they develop more of a sophistication around lying. Again, going back to adolescence, they learn a lot of things in adolescence, but they hone their skills and how to be deceptive because that's what we, unfortunately, that does not stop in adolescence. It goes well into adulthood. So another perspective on working with this population is around trauma. I talk often about, you know, we need to really pay attention to the trauma experiences that these kids have had. And so this was a study by Barra back in 2018. He looked at young men who had caused sexual harm. They were in the juvenile justice system, but he did the prevalence of ACEs. And I'm pretty sure everyone in this group knows what ACEs is, adverse childhood experiences. But when he looked at it, you can see a lot of these kids were experiencing a lot of kind of different things that were across the board. You can see emotional neglect is probably the number one, but there's a lot of even disbursement between parental nonverbal abuse, pure emotional abuse, physical neglect. And you'll notice actually one of the smaller ones is sexual victimization. And the research early on, we thought, oh, well, if these kids are sexually harming, they must have been sexually abused themselves or sexually harmed. Well, until we really started delving into it, then we found out that actually that's not true. In adolescence, it's around 40% of kids have had some type of sexually harmful or sexually abusive experience. So less than half. When you get into the younger kids, 12 and under, it's right around half. I've seen studies anywhere from 45 to 55, so a little bit above half, a little bit below half. And then when you talk about adults, adults that have caused sexual harm, it's really around 20, 25%. So the older it gets, that becomes less of an issue. Have they had other adverse experiences? As you can see by this slide, yes, they've had others. And domestic violence is a big one that's up there. So again, witnessing physical abuse or being parental physical abuse, things like that, they're definitely. So when it comes to interviewing kids, I've had a lot of people talk about, oh, well, what these kids are like, and they'll come at it from, oh, the sexual harm lens. Okay, what lens are you forming? So in the sexual harm lens, we'll sit there and say, oh, these kids deceive, they lie. This is what they do. This is how they get away with it. This is how they set it up. This is how they act it out. And this is how they get away from being in trouble. But if you take a, let's say a trauma lens, but this comes right out of the DCM or DSM, sorry, folks, but the traumatized kids, this is a PTSD diagnosis criteria. Traumatized kids have inability to recall important aspects of an event. So their memory's impaired. So are they traumatized or are they just causing sexual harm? And that's it. There's not a trauma piece here. There is a trauma piece here. And then again, you look at from a perspective, they're unmotivated and lazy. They don't want to just, they don't care. They don't want to engage and do anything. Well, traumatized kids have a diminished interest in participating in activities. They withdraw from things. They don't want to get involved. So again, which lens do you want to look at? Just a couple more. Again, these kids are cold. They're uncaring of others. They just, you know, you look into their eyes and there's nothing there. I've heard that one a dozen, more than a dozen times. But with traumatized kids, we know that they're detached and estranged from others as a self-protection. So again, what are we looking at? Last one, again, act like they don't care about the consequences of their actions. They could give a rats whatever about what they've done. They don't care. Well, traumatized kids have a sense of foreshadowed future. They don't really see much coming down the road. So it's not like they're invested in what's coming because they don't think there's anything good. They have nothing to look forward to. So again, trying to change some different respects that you've heard me, I won't drone on that one anymore. Again, creating accountability, generating disclosures. And we're going to, in the old days, when I got into this work, we'd be like, you're going to tell us everything. You're going to tell me the color of the polka dots on her underwear. And that was just, you know, what we found is that nearly didn't matter. I don't want to get a confession. I want to get honesty and how that means being responsible for the future. This is one thing I tell law enforcement a lot when they're investigating these kids. I'll be like, look, I know you want to get a disclosure, but the most important thing is that we get them to be honest. That way you get both things. And so trying not to get both, not just one. Using consequences as a deterrence. Again, I think for most of you guys would understand that that just doesn't work. We wouldn't have the largest penal population in the world, United States, but we can create capacity for them to self-regulate, for adaptive skills, for resolving conflict, and understanding about consent. Because a lot of these kids don't know about consent. And again, if they're watching pornography on the computer, which a lot of them are, they're not seeing consent. And I can tell you in a recent study, 45% of kids who are looking at pornography said that they learned helpful things from watching pornography, which scares the crap out of me. Because what, my God, are these, and we should be talking to these kids, right? When it comes to treatment, trying a one size fits all does not work. What these kids need is individualized approaches, dosing the right amount. Again, matching resources to needs. I don't want to put a Band-Aid on a gunshot wound, and I don't want to give antibiotics because somebody sneezed. I want to match that up. So paying attention. And then again, they may come in complying with treatment, but the goal is to get them out on consenting. Make that conversion from external motivation to internal motivation. So questions, I have been talking a long time, and the only one who should hear me talk that long is my own children. And they usually check out after five minutes. So please, if you have any questions, you want me to follow up on anything, or if you've had a different experience and disagree with me, I try to be research-based, but I don't know at all. I would appreciate any input. So great. Thank you, Bianca. I appreciate that. Really, any questions, let me know. I'm happy to talk on. Okay. So important to remember when you're talking about trauma, again, do understand that it plays a significant role in the background of what goes on with them, but it's not, they'll also say, well, it's not my fault because no, that's not what I'm saying. I'm not saying it's an excuse, or you don't have to have accountability. I'm saying it's a little, but understand what its role is. And that it's a major need and treatment that if I can't treat a kid for what happened to them, how are they expected to have empathy for what they did to somebody else? So lots of times, empathy is an outside-in process. It's not like you're born with empathy and you just have it. Empathy is like, you know, the baby cries, you pick the baby up, you look at the baby and the baby goes, wow, they get it. They're paying attention to me. But a lot of my kids that I worked with didn't get that. So they didn't get the empathy coming in. So they don't know how to create the empathy going out, especially if they were harmed or abused or had trauma of their own. So really want to pay attention to that. Okay. It happens to me for sure. You're on mute. Yeah. So my apologies. I usually have really good internet, so I don't know what's going on. So is everyone still there? Yeah, we can hear you. Okay. You just have to reshare your slides. Yeah, it's not a problem. Not a problem at all. Okay, folks, I'm back. Thank you. Pre holiday glitches. So anyways, I was saying, what is it when you are wrong. What does it feel like. And I can tell you right but in situations where professionally personally where I was wrong. And that feeling is not good. You know, I feel humiliated or angry, or, you know, it's just not a good feeling when you're when you're wrong right. And what I often say to folks is when they answer that question and they come back with those responses like I get angry I'm embarrassed I'm guilty. I'll say actually, that's what it feels like to know you're wrong. Because here's about doing this work, as we're doing this work. One of my favorite quotes is until we know we're wrong. Being wrong feels exactly like being right. So if you do this work long enough, you're going to be wrong. And there's nothing wrong with that, other than understanding it. But I think lots of times we in that position of, well, I, I feel right in what I'm doing or the information I'm providing or the approach I'm taking. I've learned so much from working for kids from all these years, but probably what I've learned the most is that I, there's a lot more that I don't know that I do know. And I always put this out there I do this whole training around bias and judgment and how it impacts our practice, how we interact with folks, how it affects our questioning our approach to people. And we really don't pay enough attention to what that is. And one good example is talking about listening. So I always say, when a kid's being really difficult in my old clinic what I would tell my therapist is well, what he needs is a good listening to, or she needs is a good listening to. So I try to pay attention to that. So what am I hearing from my client and what am I, I'd be getting wrong so when a kid comes up and says this is stupid I didn't do anything wrong. I'm like, okay, maybe what they're saying is I'm scared, or you think I'm stupid, because I did this, so I don't have to necessarily get the admission I have to listen to what they're really saying. That's it. Who would do that. People might think I'm broken, something's wrong with me. I'm gross they're going to look at me again, they're going to look at me in a way I don't like. And then you think I'm lying. You want me to admit to something. So, you're judging me and shame and embarrassment which is admitting you lied. Shame and embarrassment is the only way I get out of this. So paying attention to what they're telling you what they might be saying, I might have it wrong. Again, going back to those clarifying questions or repeating questions in a different way, just reframing the question again. Why, why would I do something that stupid. You obviously don't think much of me because you're already thinking I'm stupid and you think I did that. So, addressing those kind of fears and beliefs that they might have. So, I love to put this slide up because I think it's a really good remembrance that this was a great work by a guy named Thomas Gordon, and he talked about the art of listening and active listening and slow listening. And he talked about is if you're doing any of these things. You're not listening. And when you look at this list and I'll give you a moment to look at it. You kind of wonder how you could ever listen right when I first saw this list I said oh my god, I never listen. If you're in a conversation with anybody at any context but definitely work, and you're thinking because our job is we have a time frame, we have a job to do we have jet objectives and goals we got to get this stuff done right. So we're constantly like what's my response going to be, how am I going to fix this, how am I going to correct that. Do I agree with what he's saying do I disagree, how do I, how do I tell them that. So, all that stuff's going through our head right at the same time, the person in front of you is talking. And so how do you manage both of those at the same time. It's really hard. So, and again remember that one at the bottom to we think we think three or four times faster than people speak. So by like the third or fourth word into a sentence, you could already be off on a tangent, thinking about what you're going to do or how are you going to do it. You've missed two thirds, three quarters whatever of what someone's saying. So, again, my motto that I say to my clinicians all the time is slow down, you'll get there faster. I'm really paying attention to what the client is saying, because, yes, you have to do your job. But doing it wrong doesn't feel good, especially when you know you're doing it wrong. Again, I have this, I have this up in my office to keep me humble, because being humble is a really good preventative. So, when you're dealing with really problematic behavior I'm going to talk about sexual behavior, but this is what you see, you see the fan what's going on the family the school the peer relationships, again whether it's sexual non sexual, maybe delinquency issue with the things that they're saying and doing. And then the self harm, but really what we're dealing with is all this stuff down below right. So, what I talked about when you're dealing with problematic sexual behavior. This is the three legs of the stool that hold it up attachment, because this is about relationships, if you're going to harm somebody. You have to, you've got something around attachment that allows you to do that, because if you have good solid attachment. Generally you're, you don't harm other people. Trauma is a piece of it because it's not unusual right for something bad to happen to you. And now you're doing bad, something bad to other people so. Obviously the neuroscience around both of those things. So, paying attention to how your brain development, how it impacts regulation, whether it's cognitive, emotional, behavioral, whatever those are. So yeah. Great. Anyone in the chat room. We have a question I was going to wait until you were done. I know the next couple slides are behaviors as well. So I can wait until you're done with that section and then I'll, I'll put it out for everyone to hear. Great. Thanks, Angela. Appreciate it. My caveat here is yeah, this is what we are generally going on for healthy, typical healthy sexual behaviors. Again, our information is not as current as I would like it. And this has some fluidity to it. But I think these are fairly solid things to move again. I talked about developmentally congruent. So, you know, I've had, you know, 10 year olds, you know, and 14 year olds engaged in sexual behaviors, we found out the 14 year old actually really operated about an eight year old level. So even like that age difference, be careful, because it may or may not be indicative of there's a problem. So, you know, I think it's about like supervision and intervention, if that, if they're responding to that, that's healthy. You will. It's not unusual those of you who've had raised male children that once they find their penis, it becomes the center of their world right they're touching the penis all over the place. If you intervene, generally they listen to you or they apply to you. Not always, but hopefully they're paying attention to those influences that they're getting. So, again, I'm not going to go through all these, but you can you can see these are where we're trying to look at. Again, intermittent and mutual agreement or assent, because children cannot consent, but they can assent in that they know developmentally, they can agree to different things. So, yeah, paying attention to those as well. And then this is kind of worth 13 to 17 year old because again, developmentally, they're different, right, because these kids do have a full range of sexual adult sexual behaviors. And again, this is not a moral or I'm telling you what kids should or shouldn't be doing it. I'm telling you what kids are doing. So, it's not by the time kids are 17 more than half of them are exercising a full range of adult sexual behaviors that includes oral sex, anal sex, vaginal, penile sex, different, you name it. Okay, the full range of adult sexual behaviors. They may not, you know, BDSM or sadomasochism may not be, I wouldn't say developmentally in line with this age range, but about 80% of all pornography involves strangulation now. So, it's being normed. I'm not saying it should be or it's healthy. I'm telling you what kids are seeing, and I have kids I treat and they'll say they think part of foreplay is strangulation, and they're seeing it. And they're like really confused that girls aren't excited that they're strangling them. They really don't get it. And so, it's not like a deviant or an angry or sadistic. They're really normalizing. So again, take this with a grain of salt. And look again, what is experimentation? And, you know, are they able to form relationships with these kids? If they're having like intermittent sexual experiences with kids they don't know? As teenagers, that's not really common. It happens, but it's not as common. And again, so paying attention to these kind of aspects that are going on. So, do you want to do that question now? Sure, if you don't mind. So, a request came up in the comments asking if you could talk about advice for parents and guardians and thoughts around reducing future harm. Is there any guidance that can be provided to family members? Yeah, great. So, what a great question. Thank you. Whoever asked that, thank you. First is, we got to be having these conversations with kids. We've got to be talking to them. And again, I'm probably not the normal parent because I talk to my kids from early stage, but we really need, I go back to that study I was saying, just came out in 2022, where about 45% of kids were saying they're learning helpful, useful things from watching pornography. That is not what we want. We want them to learn that through healthy, connective relationships. So, I work with parents all the time. So, I actually practice with parents. I'm like, we're going to talk about sex. And I do various different things. And I will say to the parent, tell me about, can you talk about, say words like vagina and penis. Sometimes that's where I have to start with, right? But I practice with parents and say, how do you talk to your parents about like how babies are born? How do you talk to your kids about like, what are the steps in a relationship? How do you know what they are? How do you talk to your kid? So, really sitting down with parents, I can't tell you how valuable this is and how much I definitely encourage you to be talking to parents about what those steps look like. And I will tell parents, know your tolerance level, get yourself prepared. I walk them through it. And I'm like, and if you need to take a break, you say, okay, let's stop here. And if you really want to follow up and talk about this more, go back in your bathroom, cry, scream, do whatever you need to do. That's okay. And then come back. But you know, I usually dose it out with parents too. If you're not really good at it, I dose it out. I'm like, okay, you're going to talk about these two things with your kid today. You're going to talk about sexual development, like changes in voice, changes in body, and you're going to talk about like sexual interests. And, you know, every family is a little different, but there's definitely more and more probably the biggest challenge I have with families is kids on the LBGTQI or transgender kids. Those are the tough conversations. Some parents are in better positions to have those conversations. But I really try to explain to them the risks their child is at if you're not having those conversations, because those kids are definitely getting online and they're connecting to the wrong sites, the wrong people. I've had so many kids I've worked with who, you know, couldn't express their own orientation or their gender, but they could do it with someone on the internet and they were really comfortable talking to them. And I'm like, I always say with the adult perpetrators, let me tell you something that they're really comfortable at, talking to your kids about sex. So you've got to be the one giving that information. Probably like you guys, I have friends who will say, hey, Jeff, when should I talk to my kid about sex? And my response is before they ask you, because by the time they've asked you, they have talked to someone else. And it may be, not always, but it may be too late. So I really just encourage starting that conversation, start it small. I only give and talk to parents with as much as they can handle, right? Because if I overwhelm them, the likelihood is they'll never do it. So we just do it in what they can tolerate, what's palatable for them. But then I chunk it up, like, let's work on two things to talk about and let them choose, because they'll choose the things they're most comfortable with. They go and do that with their kid, that tends to go well. And then we just say, okay, let's build upon that. So it's a strength-based approach. And we just kind of work on doing that. But absolutely, can't encourage that any more than, if you can't hear it in my voice, please, we need to be talking to families. And that's where they need to be learning about it. I appreciate it's in the school. I appreciate there's other avenues and there's nonprofit agencies, but it's always the best when it's between a parent and a child, especially when that child is outside the norm, right? Transgender kids are such a risk. And so are LBGTQIA for bullying, for suicide, for mental illness, for substance abuse. A lot of that stuff's preventable. We just need to have a conversation with them. And even if it's, again, making it palatable for the parents. So sorry, I know I went on with that one, but that was such a great question and absolutely is a topic we need to talk about. We've got to talk about that. So thank you. I appreciate that. Real quick, just to kind of give you guys an idea of when we do assessment with these kids, what it looks like. Again, this is a classic, probably biopsychosocial assessment that you guys see done for a lot of kids. Obviously, I included the piece about trauma down there, because that is really important to get into. I'm not going to go through this list. These are pretty standard stuff. I will say the resiliency and protective factors are really important. It's something we tend to overlook. We tend to worry about the risk factors, which is important, but risk factors got them in the door. What's going to get them out the door? Protective and resiliency factors. So I really focus early on with kids, what are the things that are working for you? What are the strengths? What support you? And identifying those and then using those things to get them out. Again, talking about their self-perception image, we run through that. Again, my favorite phrase is slow down, you'll get there faster. I have medical concerns, and I do. I have a slide about that, sorry. Because this is a really important one in mental health, that mental health therapists, and I am one, we overlook all the time, because the DSM, everyone knows the DSM, done something mean? When someone has done something mean, we look them up in that book and we give them a label, right? But what the DSM, every version has said is do not diagnose until you rule out substance abuse and medical concerns. And so I worked at a children's hospital, so I was really fortunate. All this stuff was down the hall from me. So I found out, do these kids have any, like a seizure disorder? Is this because that can affect impulsivity and behaviors? Obviously, allergies, medications, head injuries, and not just like traumatic brain injury, that's an easy one. But I would say, like, if the kid had a concussion at soccer for the past three years, every season for the past three seasons, he got a concussion. So it may not be a big T trauma, but it might be a lot of little T trauma, and that head trauma piece, so I'm paying attention to that. Nutrition, what are they eating? We have lots of really good research on bad diets and what it does to brain development. And I don't know about you, but most of the kids I see eat sugar, salt, starch, and fat. That's their four diets. And those things are really bad for brain development. And there's actually a fair amount of research to show that. Obviously, environmental influences. Sleep disorders is huge, folks. I had a sleep study center right there on the site. I sent about half my kids there, and a third of them came back with some type of sleep disorder. And some of them were on like, we thought they had ADHD, but that's actually what sleep disorders look like. So we put them on Ritalin. And what does Ritalin do for your sleep? It ruins it. And so we were perpetuating the problem over and over again. And if I haven't said it once, I've said it like 10 times, I know auditory and visual processing disorders. These are things you want to pay attention to because they contribute to mental health problems all the time. And we don't pay attention to them. And kids with problematic sexual behaviors, I rarely seen a kid, I don't know if I have, but rarely seen a kid who didn't have a mental health issue. And so when I'm assessing kids, paying attention to these. And so if you're referring a kid out, ask the assessor, the person that's going to work with this kid, what's your assessment protocol? What are you going to do? You can be the good consumer for this kid. So paying attention to that. Oh, well, we just talked about speaking to parents, right? That's great. So I won't go too much because we talked about this, but speaking with parents, this is actually talking to parents about the problematic sexual behavior. So it's kind of related, right? So again, I always want to know what the parents' reaction to this is. Did they overreact? Did they underreact? Did they talk about it at all? What was their way to handle that? And what is the kind of the culture of your family? I ask parents in treatment, and this is treatment, so it's a little different, but I will dive into the parent's sex life. Because lots of times we find out the kids have been watching them have sex. They just didn't know. So I want to know what the type of intimacy is in the house. How can the kids access it? How are emotions shared? How is physical intimacy shared around the house? I want them to know that. I also ask them about like, who did you tell who you didn't tell? Because that will tell you somewhat how the families want to do their openness potentially. And again, obviously how sex is handled in the home. And I'll say to them, what are the kind of sex talks you've had with your kids? And I would say seven out of 10 times there hasn't been a sex talk. So I start talking to them. And I used to do a lot of in-home work, so I would be in the families. And I can tell you, well, when I got into this business, I had to worry about magazines and beta tapes when it came to pornography. Those of you remember beta tapes. But I would often walk in and I would learn a lot about a family by going into their home. And I'd see a giant stack of pornography videos sitting in the corner. So I would learn about how sex is handled. And it's both extremes. I also have families who are like, we don't talk about sex. It's not mentioned. There's no content whatsoever discussed about sex. The kids just are supposed to learn it magically when they turn 18. So I'm paying attention to those, what the norms are. And non-judgmentally, I'm not sitting there going, oh my God, you're looking at porn. I'm just like, OK, so I'll say, so how do you tell me about how you're viewing pornography might influence your kid? In a non-judgmental way, but I want them to know. Or how is it not talking about sex at all? How do you think it'll influence your child in their choices and see where they're going with that conversation? Because when you get into healthy and normative stuff and you have to have that, I've had parents say, my kid cannot masturbate. And I'm like, well, he already is. But I've got to get into that conversation slow. But you've got to get over that hump, so to speak. Again, what's the parent's position on the sexual harm? I don't need the parent to fully believe it. I can definitely work with parents who are in denial. But if a parent denies something, the worst thing we can do is confront denial in any context. Confronting denial further entrenches it and makes it a worse problem for us. So research is very clear. And if you haven't paid attention to the United States in the past six years, arguing with facts doesn't work very well, folks. You have to take a different approach. You can't start at the end and say, no, this is how it is. You have to start with, how did you get there? I know your belief. I'm not going to argue with you. I want to know how you got there. And that's going to tell you more than trying to say, no, you're wrong about this. Having a transgender child is a privilege. There's nothing wrong with them expressing. If you start there, you're going to lose that argument every time. Whatever argument it is, if you start at the end, you'll lose it every time. Again, the family's history, because guess what? No surprise, not unusual that a lot of these families, there are other family members that have been abused, often the moms. I love genograms. I learned a lot about the context of the family. And again, the developmental history, and I will, if I have a chance, I will talk to parents separately. And then I talk to the kid and I get all three stories. And that gives me a good kind of overall look at what's going on. And if I'm talking to a kid and I always ask the parent to say, look, could you tell the child, and we do this in forensic interviews, right? No matter what you say, all I care is you tell the truth. I'm going to love you no matter what you said. And I will coach parents to that. You don't have to believe it a hundred percent, but they do. So please give them permission to be honest, because as a parent, wouldn't you rather know the truth? And most are. So again, talking to parents about getting their child permission to talk about it and disclose it. And again, I don't want to tell kids, oh, there's no consequence for this, but explain what they are. If they know what's coming, if we know what that anxiety provoking thing, if we know what's coming and we know how long it's going to last and what it looks like, we do a lot better. Think about like when you go to the dentist and he says, I've got to drill your tooth because you have a cavity. And you ask the dentist, well, how long is that going to take? And the dentist is like, I don't know. I'll just start drilling and see how it goes. Your anxiety goes way up, right? When the dentist says, look, this is going to hurt midway through, it's going to last about two minutes. After that two minutes, I should be done and we'll be up. I can, I can manage that, right? I know what to expect, but this unknown, talk about anxiety provoking, right? And again, one of the biggest messages I tell families, because again, we know when parents come in and their child has been sexually harmed, how guilty they feel. Think about when your child initiated the sexual harm, the guilt and shame meter is off the charts. So I talk a lot about that. And I will always say, look, you didn't cause this to happen. You're not at fault to happen. Most of the time, that's true every once in a while, they may have influenced, but most of the time, that's a situation. But what I tell them is that you're the medicine, you're the cure for what's going to go moving forward. So I've got to have you on board. What's it going to take? And we kind of strategize and I, and what are their goals? Self-determination is a big part of what we do. What are their goals? What do they want? Just to be successful and figuring out how you can collaborate on that. You may be in a situation where reunification comes up. So again, you always start with the best interest of the impacted child. I'm not saying you neglect or negate the initiating, but the impacted child gets to have choice. They get to have control because they didn't before. And so I want it to be the least restrictive and punitive. If children have to be separated, and most of the time they do, we used to separate them like, that's it, you're never going to see each other. And we found out that actually we impacted the impacted child worse, that the trauma, the abuse came in the sexual abuse, but the trauma came by the system's response. So we have to be a little less intrusive in that and a little bit more like, okay, how do we walk through this? Not just like immediately, the guys are removed, you're not talking to each other, and you're never going to see each other again. It doesn't work very well that way. So again, trying to assess that, what that looks like. And again, when we do reunification, we kind of do that approach and back off and assess. So it might start with a letter, it might start with a phone call, it might start with a Zoom call, whatever, but we progress as the kids can tolerate it and are doing well. And then we check in and we move forward as it indicates it's best practice for what the kid needs. And for both kids, that the initiated, the impacted child may be fine with it, but the initiating child may get dysregulated by being around the child they impacted. And so we want to like, because we don't want to set them up for this to happen again, right? So both kids have a say in that to pay attention to that. Again, having a plan, but be allowing for flexibility. Supervision, I always talk like the parent needs to know, or the adult, they'll be like, we're going to have a friend next door supervise. And I'm like, there's a friend next door, know what to supervise for. So again, having knowledge on that. Being inclusive and being respectful of family rituals, values, and beliefs. A lot of DEI stuff comes up here that I am not, I'm a middle aged, cisgendered, white male. I am going to defer to my clients, beliefs, rituals. I'm going to listen to them and help them again, self-determination, guide what that is. And by taking an individualized approach, I can do that by working with them and collaborating rather than working on them because I don't work on them. Obviously having a multidisciplinary approach. I talk all the time about if you're working in an MDT, they should be seeing these cases. If they're going to see these cases, they should have policies and protocols within the MDT. Like what kids are you going to see? What kids aren't you going to see? What kids will probably go to court? What kids won't go to court? What are treatment, what does treatment look like? How are we going to, you know, all those things, a good MOU for your MDT because your MDT can really address a lot of these big issues and they get all the people to the table. They can get the school, you can invite the school in. If juvenile justice is involved, you get them in, you get all those players at the table for these kids because they need, they need all that. So in that reunification process, it's really because you can get the initiating child's therapist and the impacting child's therapist there. Again, I kind of talked a little bit about this, so I won't go through too much, but post-visit requirements, looking at, again, how is it going? And then having the treatment providers, you know, talk about it, using the MDT to kind of talk through this, having an individualized safety plan. And actually, I don't even call them safety plans anymore, I call them development plans. And that's because we're developing things like developing and promoting safety. So we talk about what that's going to be and make your safety plans about what they're going to do well, not about everything is like, don't do this and don't do that, because we used to do that. Like, don't be in a room alone with them. Don't, I'm like, if you talk about positive, again, protective and resiliency stuff, if they're doing the right thing, most likely is they're not doing the wrong thing. So really promoting that as well. And again, assessing that after each vision really is important to know how it's going together. So if you are interviewing one of these kids and you get disclosure in that process, and again, I'm not saying use the forensic interview that way, but if it's an assessment process or other process, you know, one thing is don't, for you, don't overreact, don't underreact either. Just indicate the importance of them being open and honest. Again, paying attention to your facial expressions, note-taking, I talked about that. But, you know, if you're like, so if there's anything else, again, if you can see my face, if there's anything else you want to tell me, that tells a kid not to tell me anything else. So paying attention to that. If you can keep them talking and illicit stuff, awesome. That's the whole point of it. And again, you guys are pretty well aware of clarifying the who, what, when and where and what techniques to use in that. And then always summarize, like, so let me get this right. And you kind of cover all that stuff one more time. I, when I wrap it up, I always giving lots of affirmations to kids, even if they told me one thing, they told me one thing I didn't know in that whole interview that I didn't know before, maybe they told me 10, great. But even if it's one thing, I give them acknowledgement for that. And I talk about great for taking responsibility, again, no matter how minimal. And then answer the like, they're going to want to know what's going to happen next. So you want to be sure you're ready to answer those questions, and that you do answer those questions and let them know because they most kids, what are they worried about? If they're going to get in trouble, what's going to happen from here, and my parents are going to be pissed at me, I would tell you most of the time kids are most worried about what their parents are going to say, or what kind of trouble. So addressing that stuff is really, really important. Discussing safety, obviously, what if there's is a safety or development plan, adjusting that, explaining next steps, and then going back to your team and consult with it. Because you have all this information, going back to like judgment and bias problems that can happen. If you have a really good team, that's what the team is for sitting down and staffing this case, doing case conceptualization, trying to figure out where it goes from that, there's a diagnostic process, there's a formulation process. So using the team, do not, I always have a question, do not be your own reality. I don't want to be my own reality, I use other resources all the time, because I don't want to be in that position, but I definitely want to want to promote that by talking to other people and getting different perspectives. So these are a bunch of resources, and I'll leave this slide up, you can use there's, I have an 11-year-old, so I have QR codes, I'm really cool now, so I figure out how to do, and that's probably why they're dinosaurs in the QR codes, but any of those QR codes will take you to those. These are four of the big ones, there's definitely other resources, and if you email me, I'm happy to share. I have a ton of resources around kids, working with these kids, but the National Center on Sexual Behavior of Youth is at the University of Oklahoma, they have a ton, NCA, where I work, we have a whole section for problematic sexual behavior on various discipline issues, treatment issues, all kinds of different stuff. The National Child Traumatic Stress Network, I know most of you are familiar with that, they have great resources as well, if you go there, just type in problematic sexual behavior, it takes you to a whole section, and then again, the Association for the Prevention and Treatment of Sexual Abuse, has great, they've actually just released all their stuff to the public, it used to be you had to be a member, but they now release all this stuff to the public, so if you go on their juvenile, it's a juvenile site, but they have children stuff too, they just released actually their child standards for under 12, so it's a really good resource, and I'm happy to share these slides later, so folks here have it, and if not, this is my contact information, that's my email, I'm happy to take calls, my job is coordinating mental health services around the country for CACs, so I talk and work with people around the country, and PSB is my passion, I've been doing it since the late 80s, and I'm happy to help out or provide resources or information, so, and I think that's it, let's see some questions. If I wait to see if there's any questions, thank you so much, this has been a really great presentation, you gave some really good information, so thank you so much, so far it doesn't look like there's any questions, so we'll get the, since Jeff is okay with us sharing the slides, we'll get the slides PDFed out to you all, everyone that's here today, and then we'll also attach them to the archive webinar as well, so you have access to them through the archive as well. That being said, you guys still pay attention, if you have any questions, feel free to drop them in the chat, we're still here, Mary Kate has dropped the evaluation in the chat, we talked about it before, but just in case anyone wasn't there in the beginning, the evaluation link is in the chat, you can complete the evaluation link for a certificate of attendance, there's also going to be a few questions to prompt you to see if you are a nurse that's looking for CEs, who's also a member, if that is the case, information will be sent back to us, and after January 2nd, we will be reaching out to you all with a new evaluation that will give you CEs from that. As I said before, today's webinar is through our safetya.org, our safety project, you have the ability to reach out to IFN through safetya with any technical assistance request, you can do that via telephone, simply by calling 1-877-819-7278, or you can submit a request form through safetya.org. This is our last webinar for 2023, so again, thank you guys for being here, and thank you Jeff for closing this out, and of course we're going to have more webinars to come for 2024, so keep an eye out for marketing around those webinars. And with that, I want to say happy new year to everyone, I want to say thank you to Mary-Kate and the staff on TA to TA to assist us today, and then Jeff, I know I can't thank you enough, but thank you for being here and doing such a great presentation. Happy holidays everyone, and yeah, I guess we'll talk to you soon, there's a quite a few of you that I'm familiar with, so it's good to see you guys here, and I look forward to talking to everyone in 2024. Jeff, looking forward to connect with you in 2024 as well. Yeah, you guys take care. Bye.

problematic sexual behavior

children

youth

prevalence

developmental pathways

interviewing strategies

person-first language

consent

recidivism rates

trauma

professionals

treatment effectiveness